The child who frequently seems vacant, inattentive or preoccupied could be suffering from absence epilepsy, writes Reva Klein.
Put yourself in this situation: you are studying Japanese on an evening course. It requires concentration and alertness. The teacher is keen on interactive learning - you know the type. It is a class of about 24 adults and every 10 minutes or so you are required to pair up for an activity or else be called on by the teacher to show you are on track. A slightly daunting scenario, at the best of times. But imagine that there are no best times for you.
Imagine that your brain is programmed to blank out 20, 30, 40 times a day for five or 10 seconds a time. To the outside world you are sitting there quietly, daydreaming perhaps or preoccupied. But in reality there is no dream, no thought, no nothing. It is just as if someone momentarily pulled the plug on your brain. These recurrent disruptions are enough to throw you off course, leaving you unaware of what has been said for that brief period and having to pick up the pieces afterwards. And as it happens time and time and time again, those pieces are really hard to pick up and connect together in a way that has meaning.
That is what things have been like for 16-year-old Kerry O'Donoghue for a large part of her life. Variously ticked off and ignored at nursery and reception class because of her constant "daydreaming", she was five before her aunt, a nurse, identified her repeated vacant looks as absence epilepsy. For her mother, Hilary, the news was a bolt from the blue. "I thought before then that epilepsy meant grand mal seizures. I didn't realise that there were other types. But because of my sister-in-law's chance comment, we got the referral we needed from the GP and, within six months, we'd been to a specialist unit and got the diagnosis, Kerry was prescribed the medication she needed and the trances had stopped."
Kerry's story is not unusual. She is one of 420,000 in the UK with epilepsy. It is the most common serious neurological condition and usually makes its first appearance before the age of 20. So during your teaching career, it is probable that you will have at least one child with epilepsy in your class. While more obvious forms of epilepsy (see box) are diagnosed and treated promptly, absence epilepsy can go on for years before it is identified. The problem is that its symptoms are subtle and easily confused with laziness, dreaminess or inattention, traits that all children are prone to. But there are differences and persistence of the symptoms is an obvious sign.
Hilary describes Kerry's behaviour during a seizure. "She'd be in the middle of a sentence, say, and suddenly her eyes would glaze over and everything would stop for a few seconds. Then there'd be a slight hesitancy and she'd pick up where she left off."
The impact of absence epilepsy on a child's education can be devastating, says Fiona Ingham. "It may not be dramatic-looking, but having these absences many times a day can ruin a child's ability to learn." Fiona speaks from professional and personal experience. She is possibly the only volunteer epilepsy liaison workers in the country, working with Bury health authority and local schools to support children with epilepsy and give training and guidance to teaching staff. As a former primary and special needs teacher, she knows the local schools, what teachers need to know and "what turns them on and off".
She also knows what it is like to have epilepsy. She has two forms: simple partial and complex partial seizures. She was not diagnosed until she was 26. "I've had seizures since I was nine. School was a nightmare from begining to end. So I have real empathy for any child having 'funny turns', having to struggle through school."
Hilary O'Donoghue, who runs the Milton Keynes branch of the British Epilepsy Association's parents and carers support groups, believes that "teachers are not informed about epilepsy. Either they're frightened of grand mal seizures or they don't pick up absences. What I would say to teachers is that if they have a child in their class who's persistently daydreaming, has poor attention and displays a blank look, don't automatically assume that the child is lazy. Consider the possiblity that it's epilepsy and speak to the parents. With medication, the seizures can be treated and the child can carry on in mainstream."
For her own daughter, Kerry, diagnosis and treatment came too late to make up for all the time she had lost during her frequent absences. She was getting nowhere in mainstream and has been in a school for moderate learning difficulties since Year 6, where her confidence has grown and she is getting better at retaining information, although her short-term concentration is still poor.
Although many teachers are not alert to absence epilepsy, Fiona Ingham knows of one whose vigilance and intervention made all the difference to a seven-year-old boy. "She noticed that several times a day the boy was looking glazed. She'd had some experience of this type of epilepsy with a former pupil and immediately spoke to the parents about her suspicion that he might have absence epilepsy. They saw a specialist and the teacher's suspicions were confirmed. This shows how important it is to raise teachers' awareness of this condition."
TYPES OF EPILEPSY
Tonic-clonic seizures (grand mal): known as epileptic fits. The muscles contract, forcing the air out of the lungs, the body stiffens then jerks uncontrollably. The child falls down unconscious. They may let out strange sounds, dribble or be incontinent. The seizure slows down and stops after a few minutes.What to do: be calm and reassure the other children. Cushion the child's head with something soft but don't try to restrain their movements. Do not put anything between the teeth or in the mouth and do not give anything to drink until the seizure is over. Gently loosen tight clothing around the neck, taking care not to frighten the child. Once the movements subside, turn the child on to their side to aid breathing and wipe away saliva. Cover the child if they have been incontinent. The child may be confused and distressed: be comforting and allow them to rest quietly in a private place.
Do not call for an ambulance or doctor unless: the seizure lasts more than five minutes or there is a series of seizures or a child not previously known to have epilepsy has a convulsive seizure.Absence seizures the child stops what she or he is doing, stares, blinks or looks vacant for a few seconds, then carries on with what they were doing.Simple partialcomplex partial seizures jerking or twitching or sensations such as dizziness or nausea occur while the child is fully conscious. These may come just before a more serious seizure.Complex partial seizure (temporal lobe epilepsy) accompanied by strange behaviour such as plucking at clothes, smacking lips or appearing drunk.
WHERE TO FIND HELP The British Epilepsy Association provides advice and information to professionals and members of the public on most aspects of epilepsy. It runs a freephone helpline on 0808 800 5050 and has a comprehensive website www.epilepsy.org.uk which features a teachers' guide. The BEA's Department of Health-approved interactive CD-Rom on epilepsy is being distributed free to all secondary schools